Osteoporosis is a metabolic bone disease in which the amount of bone decreases and microstructural changes in bone tissue occur. This reduces bone strength and increases the risk of fractures. At the Yusupov Hospital, rheumatologists conduct examinations for osteoporosis using modern instrumental and laboratory research methods. To treat patients, doctors individually select effective medications registered in the Russian Federation. They are highly effective and have a minimal range of side effects.
Loss of bone mass in osteoporosis occurs gradually and is often diagnosed only after fractures. After menopause, women experience the highest rate of bone loss. It reaches 2–5% per year. As a result, by the age of seventy, a woman loses from 30 to 50% of her bone mass, a man – from 15 to 30%. Early diagnosis of osteoporosis allows doctors at the Yusupov Hospital to prevent serious complications of the disease.
What is osteoporosis
Osteoporosis is a disease that occurs when there is severe loss of bone mass or its slow formation. This causes the skeleton to weaken and the likelihood of fractures increases. Every person over the age of 50 who has suffered a fracture should be tested for osteoporosis. The main cause of the disease may be a long history of smoking, digestive problems, and metabolic failures. In adulthood, osteoporosis is a consequence of poor absorption of calcium by the body. The disease can occur in people with high levels of sweating, low weight, and those who lead an inactive lifestyle.
Signs and symptoms of osteoporosis
In the early stages, the disease is asymptomatic. Later it leads to pain in bones and muscles. The progression of the disease leads to the development of acute pain. It often spreads to other areas, lasts for 7 days, and then subsides over several months. Diagnosis of osteoporosis in women should be done if there is pain in the back or lower back, as well as in the extremities. Reduced bone density due to osteoporosis can lead to disability. Based on laboratory tests, a specialist can prescribe treatment in a timely manner and prevent the development of the disease.
Diagnosis of osteoporosis in women and men
There are several methods for diagnosing osteoporosis. Each of them has minimal information content; the best results are obtained with the integrated use of procedures. Diagnostics includes the following types of procedures:
- biochemical blood test for osteoporosis;
- hormonal analysis;
- Analysis of urine;
- analysis of the skeletal system;
- etc.
Analysis of urine
Urine tests for osteoporosis in women can detect the presence of inorganic phosphorus and deoxypyridinoline.
Normally, phosphorus should not exceed 13 to 43 mmol/day.
A high level indicates an overdose of vitamin D, rickets, and the appearance of kidney stones.
A low level indicates metastases in the blood, an infectious focus in the body.
Normally, the level of DPID in the blood should be 3.6-4 in women and 2.3-5.6 in men.
A high level indicates the presence of osteoporosis and metastases.
Low content is typical for the body's recovery after illness. Two days before diagnosing the condition of the skeletal system, you need to exclude alcohol and certain medications.
Ultrasound
The technique consists of analyzing the intensity of the ultrasonic pulse. The procedure is necessary to determine the level of mineralization of the skeleton, as well as susceptibility to mechanical stress. In bone tissue with low density, the sound wave travels slowly. Due to the small size of the device, the study is accessible to distal areas of the skeleton. Like a blood test for osteoporosis, the test reveals bone characteristics and determines the risk of fractures.
CT densitometry
What is the name of the osteoporosis test that produces a three-dimensional image of the bone structure? CT densitometry. The device determines the density of the fabric and then compares it with the sample. This method sets:
- location of the spinal column;
- level of vertebral changes;
- density of bone layers.
The disadvantage of this method of diagnosis and further treatment is the high dose of radiation during the analysis process. In addition, computed tomography is an expensive procedure.
MRI
MRI is rarely used to analyze a patient's condition. If the doctor suspects you have osteoporosis and determines what tests need to be taken, then the prescribed magnetic resonance imaging will provide a three-dimensional image of the condition of the internal organs. The procedure reveals the density of the bone structure.
Radiodensitometry
This method of diagnosis when symptoms of osteoporosis appear is based on the use of x-rays. A special device is used to determine bone density. To make a diagnosis, two areas are analyzed: the femur and the vertebrae in the lower back. The computer calculates the density of the fabric and then compares the result with the samples.
Genetic research
The procedure involves determining the norm of collagen, collagenase, and calcitonin. Allows you to identify the risk of developing the disease, the level of predisposition to fractures. Genetic analysis can help prevent the development of osteoporosis. During the study, gene mutations are identified that could lead to a decrease in bone density.
Basic principles of treatment of bone osteoporosis
In most cases, depending on the cause of the disease, drug therapy is prescribed, which successfully combats the increased decrease in bone density. Taking medications is called basic treatment, since many medical data indicate that without inhibiting catabolic processes in the bone, the development of the disease cannot be stopped. For an increase in bone mineral density to occur, medication must be used. Without them, it will not be possible to create normal conditions for restoring the proper function of the calcium-phosphorus system in the body.
How is osteoporosis treated?
Based on the results of many clinical trials, these classes of drugs have proven immediate effectiveness in the treatment of osteopenia:
- Hormonal agents. This class of medications includes estrogen and its derivatives, androgens, and their metabolites. Sex hormones belong to a group of drugs that have a direct anabolic effect on the entire body. Androgens (estrogens to a lesser extent) contribute to the fixation of calcium in the bones and retain sodium and potassium in the body. They support muscle mass, so they are also prescribed for severe symptoms of senile sarcopenia. Hormones are prescribed only if there are strict indications for use and there are no contraindications. If the patient has high levels of bad cholesterol, high blood pressure, liver problems, a history of cancer or diabetes, then it is better to refrain from taking hormones.
- Anti-catabolic agents. The group of anti-catabolics includes salmon calcitonins and bisphosphonates. These medications are the first line of choice if pharmacological treatment for osteoporosis is required. Anti-catabolics reduce the rate of bone tissue resorption by suppressing the activity of osteoclasts and at the same time accelerate the synthesis of osteoblasts - bone cells. This combination of effects, along with a high safety profile, makes this group of drugs most often prescribed for the treatment of osteopenia.
- Parathyroid hormone preparations. They are prescribed for the purpose of replacement therapy when bone osteoporosis was caused by hypoparathyroidism, a pathological condition against which there is an accelerated decrease in bone mineral density. To correct the situation, the prescription of a bioidentical hormonal analogue is required. The medication is used carefully, carrying out careful laboratory monitoring in a timely manner.
- Calcium and vitamin D preparations. These are auxiliary components that are prescribed as a supplement to the main therapy. It is important to understand that in the presence of already formed osteoporosis, it will not be possible to compensate for losses only with the help of supplements. Metabolic disorder occurs at the hormonal level, so basic therapy is required in combination with vitamin and mineral complexes that enhance the response to treatment. Calcium should be selected in the most bioavailable form (examples - lactate, citrate, malate). The recommended forms of vitamin D are D2 or D3 (the latter is 2 times better absorbed). They may also prescribe a bioactive form of calciferol if there are problems with the absorption of previous forms.
Non-steroidal anti-inflammatory drugs, opioid analgesics and chondroprotectors may be prescribed as part of symptomatic therapy.
Blood analysis
A blood test allows you to determine the general condition of the body, including the metabolism of phosphorus and calcium. They are washed out of the body during the course of the disease. In the presence of disease, the exchange of these elements is disrupted. Old cells are destroyed by osteoclasts so quickly that osteoblasts do not have time to be replaced by new ones. This leads to bone porosity.
Inorganic phosphorus
The main purpose of phosphorus is to ensure the growth of bone tissue and maintain its integrity. The content of an element in the blood allows us to determine the rate at which it is absorbed into the intestines. Normally it is 0.87-1.45 (mol/l).
Marker D-Cross Laps
Determines the intensity of leaching of useful minerals from the body. The norm for men is less than 0.580 ng/l. The norm for women is less than 0.573 ng/l.
Osteocalcin
Blood biochemistry allows you to determine the amount of bone protein that is produced by osteoblasts. The norm for men is 14-46 ng/ml, for women – 15-46 ng/ml.
Alkaline phosphatase enzyme
A high level of the enzyme in the body indicates the presence of bone pathologies. The norm for men is less than 115 u/l, for women – less than 105 u/l.
Calcium
Calcium is an element that forms bone tissue. The norm for men and women 18-60 years old is 2.15-2.56 mol/l, from 60 years old – 2.05-2.55 mol/l.
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Prevention of osteoporosis
The following preventive measures will help prevent the disease:
- physical activity (gymnastics 20 minutes a day);
- diet high in calcium, magnesium and zinc;
- minimizing fatty foods in the diet;
- air baths (in the presence of sun will help obtain vitamin D);
- minimizing the consumption of salt and sugar, alcohol;
- consumption of chlorine-free water;
- treatment of chronic diseases.
In the early stages, osteoporosis is asymptomatic. It is recommended to undergo regular diagnostics for both women after 40 years and men. When the first symptoms of the disease are detected, it is necessary to undergo a preventive examination.
Recommendations
Following these tips will make your bones stronger and help you avoid possible fractures.
Watch your weight
To calculate your ideal body weight, use the formula for calculating your body mass index (BMI): weight (in kg) divided by height (in meters) squared.
BMI = weight (kg) / height (m) squared
For example, height 160 cm, weight 60 kg, BMI = 60: 2.56 = 23.4
A body mass index of 20 to 25 is normal for most people . Low BMI - less than 20 kg/m2.
Avoid falls
- If you have gait disturbances, dizziness, or if you are taking sleeping pills, be careful when walking.
- Reduce clutter, keep hallways, walkways and staircases clear, and secure wires.
- Use non-slip mats and grab bars in bathtubs.
- Use handrails along stairs.
- Wear stable, low-heeled shoes.
Eat foods containing calcium and vitamin D
For women after menopause and for men over 50 years of age, the daily calcium requirement is 1500 mg. At a younger age, the daily calcium requirement is 1000 mg.
The amount of calcium consumed with food per day can be calculated using the table below.
Calcium content in food (per 100 g of product)
- Milk or any fermented milk products - 120
- Ice cream – 100
- Plain yogurt - 200
- Fruit yoghurt – 136
- Hard cheese (Cheddar, Eddam, etc.) - 750
- Swiss cheese – 850
- Soft cheese (like Brie) – 260
- White chocolate – 280
- Milk chocolate – 220
- White bread – 170
- Black bread - 100
- Sardines in oil (with bones) – 500
- Canned salmon (with bones) – 85
- Spinach (fried) – 145
- Baked beans – 55
- Halva – 670
- Almonds – 230
- Concentrated orange juice (no sugar) – 35
- Orange 1 medium – 70
- Rice (cooked) – 230
- Egg 1 medium – 55
The most calcium is found in dairy products . One liter of milk or kefir contains the daily requirement of calcium.
To calculate your daily dietary calcium intake, you can use the following formula: Daily calcium intake (mg) = dairy calcium (mg) + 350 mg
In addition to calcium, an adequate supply of vitamin D is necessary . Vitamin D plays an important role in bone formation by increasing calcium absorption. Vitamin D is produced in the skin when exposed to sunlight. During long winters, the production of vitamin D practically stops. In addition, vitamin D is found in some foods, for example, fatty fish (herring, sardines, salmon). The vitamin D requirement for men and women over 50 years of age is 800 IU per day.
Take medications that increase bone strength (after consulting your doctor)
If a diagnosis of osteoporosis is established, the doctor quite often prescribes drugs that normalize bone turnover. When taken, the formation of bone tissue begins to prevail over its resorption, and the bone becomes denser and stronger.
Stop smoking!
Avoid excess alcohol intake!
Exercise, move more and walk!
The important thing to remember is that exercise keeps your bones healthy for as long as you exercise. When performing exercises, it is important not to overdo it. Some exercises, such as jumping, bending forward, spinal rotation, and sudden movements can lead to fractures. Such exercises cannot be performed if you have osteoporosis.
Examples of exercises for osteoporosis:
- One leg is bent at the knee, the other is laid back, hands on the belt.
- Half squat as low as possible 4 times. Change the position of your legs.
- Elbows bent, arms at shoulder level, spread your arms and shoulders back, squeezing your shoulder blades.
- Standing, hands clasped in front of you. Raise your arms up in front of you, bend over, placing your foot back on your toes. Lower your arms down to your sides.
- "Bicycle" with two legs.
- “Horizontal scissors” (crossing straightened legs).
- Lying on your back, legs bent at the knees, raise your pelvis, hold the position for 5-7 seconds (keep your stomach pulled in), take the starting position.
- Lying on your side, move your right leg straight out at an angle of 30–450, holding it for 5–7 seconds. Repeat on the other side.
- Lying on your left side, right leg laid back, move it forward, describing a semicircle, then move it back (also through descriptions of a semicircle). Repeat on the other side.
- Alternately raise the left and then the right straight leg, holding for 5 - 7 seconds.
- Lying on your stomach (arms along your body), lift your shoulder girdle off the floor, holding for 5-7 seconds.
- Raising the head, shoulder girdle and both straightened legs, arms are raised forward (boat) or spread to the sides (swallow).
- Standing on all fours, alternately lift the opposite leg and arm, hold for 5–7 seconds. Repeat, changing the position of the arms and legs.
- Hands supported at the back. Raise your pelvis as high as possible and hold for 5–7 seconds. Lower.